目的 研究细胞中核因子κB(Nf-κB)、Nrf2在实验性胎粪吸入急性肺损伤肺组织中的表达及作用机制,为临床研究提供相关诊疗依据.方法 选用30只健康大鼠,日龄10～14 d,采用随机数字表法分为生理盐水组、生理盐水+胎粪组、胎粪组,三组大鼠气管内分别注入1 mL/kg生理盐水、0.5 mL/kg生理盐水+0.5 mL/kg胎粪、1 mL/kg胎粪,造模后取肺组织,观察HE染色下肺组织的损伤性改变,应用免疫组化方法检测大鼠肺组织中Nf-κB、Nrf2的表达变化,应用酶联免疫吸附(ELISA)方法检测各组肺组织中Nf-κB、Nrf2抗体含量.结果 生理盐水组、生理盐水+胎粪组、胎粪组Nf-κB表达水平分别为(0.092±0.0507)、(0.131±0.0742)、(0.209±0.0234),Nrf2表达水平分别为(0.0524±0.0143)、(0.124±0.0316)、(0.228±0.0871).HE染色可见随着胎粪的吸入浓度的增加,肺组织的损伤性变化增强;在胎粪致大鼠急性肺损伤模型中Nf-κB通路在肺组织中表达增强,表达程度随着胎粪吸入程度的加重而增强;Nrf2信号通路表达增强,表达程度随着胎粪吸入程度的增加而增强.结论 胎粪吸入促进Nf-κB在肺组织中的表达增加,说明Nf-κB炎性因子的活化是胎粪诱导肺损伤发生的重要机制;胎粪吸入促使信号通路Nrf2在肺组织中的表达增加,说明胎粪吸入通过激活Nrf2信号表达发挥氧化应激作用.

Objective:To analyze the epidemiological characteristics of acute paraquat(PQ)poisoning in children in southwest Shandong, and the risk factors for pulmonary interstitial fibrosis.Methods:This retrospective study was performed on the clinical data of children with acute PQ poisoning admitted from January 2013 to December 2017 in 12 hospitals in southwest Shandong.All participants were divided into pulmonary interstitial fibrosis group and no pulmonary interstitial fibrosis group on the basis of the chest CT 14 days after poisoning.The epidemiological characteristics and risk factors of pulmonary interstitial fibrosis were analyzed.Results:During the study period, a total of 307 children with acute PQ poisoning were admitted to 12 hospitals, of which 61 (19.87%) were suffering from acute PQ poisoning.Forty-nine cases with complete clinical data were analyzed, including 26 male and 23 female patients poisoned by oral.The age distribution ranged from 8 months to 14 years.Poisoning mainly occured from July to September of each year.The mortality of acute PQ poisoning was 8.2%(4/49), and the incidence of pulmonary interstitial fibrosis in survival patients was 44.4%(20/45). Statistical differences ( P<0.05) were found between the pulmonary interstitial fibrosis and no pulmonary interstitial fibrosis, with regard to the times of blood purification, the time from poison exposure to blood purification, the application rate of glucocorticoids, the concentration of PQ in urine, the pediatric critical illness score, the time from poison exposure to gastric lavage, the white blood count at admission, serum creatinine, arterial blood lactate, PaO 2, PaCO 2, and PaO 2/FiO 2; however, there was no significant difference in the proportion of blood purification treatment, the mode of blood purification treatment, alanine aminotransferase, aspartate aminotransferase, urea nitrogen, creatine kinase and troponin.Stepwise logistic regression analysis showed that the time from exposure to poison to gastric lavage( OR=0.683, 95% CI 0.210-2.222)and to blood purification( OR=0.0133, 95% CI 0.004-0.042), the times of blood purification( OR=2.862, 95% CI 1.450-5.648), concentration of PQ in urine( OR=1.435, 95% CI 1.085-1.898), and the use of glucocorticoids( OR=0.190, 95% CI 0.048-0.757) were the risk factors for pulmonary interstitial fibrosis( P<0.05). Conclusion:Early gastric lavage and blood purification, increasing the frequence of adminitrating purification appropriately, using low-dose glucocorticoids can reduce the incidence of pulmonary interstitial fibrosis of children with acute PQ poisoning.

目的 比较分析中医及中西医结合治疗老年单纯收缩期高血压的临床效果差异.方法 选择我院住院部2015年8月～2016年1月间收治的老年单纯收缩性高血压患者80例作为观察对象,按照入院编号奇偶性方法进行分组,分别将40例患者纳入对照组、观察组中.对照组患者用中医方案治疗,观察组患者用中西医结合方案治疗.观察血压变化以及用药期间安全性及两组患者经不同用药方案治疗后在临床效果方面的差异.结果 治疗后,观察组SBP为(141.2±5.6) mmHg,显著低于对照组,差异有统计学意义(P＜0.05),DBP为(78.5±2.5)mmHg,与对照组比较差异无统计学意义(P＞0.05).两组患者用药期间不良反应发生率比较差异无统计学意义(P＞0.05).结论 中西医结合治疗老年单纯收缩期高血压的效果确切,可短期内降低患者SBP水平,且用药期间不良反应轻微,兼具安全性价值,值得临床推广应用.

目的：探讨长期应用吸入型糖皮质激素（ ICS）对哮喘儿童生长发育的影响。方法选择30例哮喘儿童为观察组，30例年龄与之匹配的健康儿童为对照组。观察组予丙酸氟替卡松吸入治疗2年。比较两组随访起点（观察组治疗前）及随访终点（观察组治疗满2年）身高、体质量。观察组用药前及用药6、12、24个月时分别抽取两组空腹静脉血，分离血清，采用ELISA法检测血清IGF-1、IGFBP-3水平，采用放射免疫法检测血清LEP、BGP水平。结果两组随访起点及终点身高、体质量，血清IGF-1、IGFBP-3、LEP、BGP水平均无统计学差异。结论长期应用ICS对哮喘儿童生长发育无明显影响。

Objective To analyze the early effect of vitamin D on interleukin IL-2 (IL-2) levels and the im-mune globulin protein concentrations in premature infants. Methods Two hundred premature infants were selected in our hospital from September 2013 to September 2014, including 100 infants of small age and 100 infants of older age. The small age infants and the older age infants were then divided into observation group and control group accord-ing to the random number table, respectively:observation group 1 and control group 1 of small age infants, observa-tion group 2 and control group 2 of older age infants, with 50 cases in each group. The infants in control group 1 and control group 2 were given formula feeding three days later born, while the infants of observation group 1 and observa-tion group 2 were given oral vitamin D based on formula feeding. At postnatal 3 d and 10 d, the serum IL-2 and immu-noglobulin G (IgG) and immune globulin A (IgA), immunoglobulin M (IgM), 25 hydroxyvitamin D [25-(OH)D] lev-els were determined, and infants’health status were analyzed. Results The average values of serum 25(OH)D con-centration at postnatal 3 d and 10 d were (22.921 ± 6.253) nmol/L, (27.51 ± 6.932) nmol/L in observation group 1 and (28.121±8.253) nmol/L, (33.192±8.932) nmol/L in observation group 1, with statistical significant differences between the two observation groups (P<0.05). And the 25-(OH)D concentrations in the two observation groups were signifi-cantly higher than those in the two control groups (P<0.05). The average values of IL-2 level at postnatal 3 d and 10 d were (3.121±2.19) pg/L, (4.623±2.80) pg/L in observation group 1 and (3.29±1.12) pg/L, (3.35±2.32) pg/L in observa-tion group 2, with statistically significant differences between the two groups (P<0.05). The IL-2 levels at postnatal 10 d were significantly higher than those at postnatal 3 d in the two observation groups (P<0.05). The IL-2 levels in observation group 1 were significantly higher than those in control group 1 (P<0.05). The serum IgA, IgG, IgM con-centrations at postnatal 3 d and 10 d showed no significant changes (P>0.05). Conclusion Early preterm infants tak-ing appropriate vitamin D helps improve the IL-2 and 25(OH)D concentrations and enhance immunity, but the effects of vitamin D on IgA, IgG, IgM concentrations are yet to be confirmed.

Objective To explore the clinical value of trace arteral blood lactate level on evaluation of pathognentic condition in neonates.Methods 150 neonates were treated in Neonatal Intensive Care Unit(NICU)of Dongying People′s Hospital from June 2010 to May 2011.The Neonatal Critical Illness Score(NCIS)were evaluated and the lactate levels of arterial blood were measured dynamically.Correlation between NCIS and arteral blood lactate concentration was analyzed and the linear regression equation was built.Results Trace arteral blood lactate concentration was negatively correlated with NCIS(r=-0.822,P=0.000)and the linear regression equation was arteral blood lactate concentration=11.865-0.106×NCIS.According to the arteral blood lactate concentration,150 neonates were divided into three groups:non-critical group(<2.325 mmol/L),critical group(2.325-4.445 mmol/L)and extremely critical group(>4.445 mmol/L)and the mortality of the extremely critical group was 29.17%(7/24),which was significantly higher than that in non-critical group [0(0/52)]and critical group[1.35%(1/74)](χ2=20.053,P=0.000).Conclusions The level of arterial blood lactate could be used as a simple and sensitive marker in the evaluation of pathogenetic condition in neonates and also be helpful for the clinical observation and treatment.

目的 探讨新生儿急性生理学评分围生期补充Ⅱ(SNAPPE- Ⅱ)在危重症新生儿中的应用及其与血乳酸的相关性.方法 回顾性分析2010年6月 - 2011年5月我院新生儿重症监护病房(NICU)连续收治的150例新生儿的临床指标,观察其SNAPPE-Ⅱ的各项指标、综合评分及其血乳酸水平与死亡的关系,对病儿SNAPPE-Ⅱ、动脉血乳酸水平进行相关性分析.结果 非危重组、危重组和极危重组病儿病死率比较差异有显著性(x2=27.018,P＜0.05)；死亡组的SNAPPE-Ⅱ总分明显高于存活组(Z=4.518,P＜0.05),死亡组的动脉血乳酸水平亦高于存活组(t=-7.630,P＜0.05)；危重症新生儿总体动脉血乳酸水平与SNAPPE-Ⅱ总分呈正相关(r=0.683,P＜0.05).结论 SNAPPE-Ⅱ总分与动脉血乳酸水平呈正相关,两者对新生儿死亡有一定预测价值.

目的:观察新生儿缺氧缺血性脑病(HIE)血清可溶性Fas(sFas)和可溶性Fas配体(sFasL)水平与血清酶的变化关系及临床意义的研究.方法:选择新生儿HIE病儿48例,按临床分度分为轻、中、重度3组.应用双抗体夹心酶联免疫吸附法(ELISA)测定血清中sFas、sFasL含量,日本全自动生化分析仪Olympus AU1000测定血清酶.结果:①急性期轻、中、重度HIE病儿血清AST、mAST、LDH、CK、CK-MB和α-HBDH活性均明显高于对照组.②相关分析显示,HIE急性期血清sFas水平与AST、mAST、α-HBDH呈正相关(P<0.01),而与LDH、CK、CK-MB间均无明显相关性(P＞0.05);而血清sFasL水平与AST、mAST、CK-MB、α-HBDH呈正相关(P<0.01),而与LDH、CK水平间无明显相关性(P＞0.05).结论:①提示Fas/FasL介导的细胞凋亡在HIE脑损伤和心、肝、肾等多脏器损伤中起重要作用.②进一步说明了缺氧缺血脑损伤后伴随神经细胞凋亡的同时,还伴随着全身重要脏器的炎症损害.③在脑损伤后随疾病进展Fas/FasL系统平衡发生失调,sFas的抗凋亡保护作用明显不足,多脏器损害也随之加重.

烯醇化酶是糖酵解过程中的关键酶,其同工酶7型特异性地存在于成熟的神经元和神经内分泌细胞中,被命名为神经元特异性烯醇化酶(NSE),是中枢神经特异性蛋白质.脑内NSE水平是周围神经的10～100倍.临床研究显示,NSE是中枢神经元损伤的敏感和特异性标志[1].而高胆红素血症、围生高危因素、中枢神经系统感染等多种因素可对中枢神经系统产生毒性作用,特别对脑干听觉通路的影响,可引起神经性听力丧失.现就NSE在上述小儿相关疾病中的临床意义综述如下:

新生儿缺氧缺血性脑病(HIE)发病机制十分复杂,是多种机制综合作用所致的一系列生化连锁反应的结果.近年来对其发病机制的研究不断深入,但尚未完全阐明.现将发病机制的国内外研究进展综述如下.